Provider Demographics
NPI:1669463311
Name:MOYA, PAQUITA LEE (LIC 8231)
Entity Type:Individual
Prefix:
First Name:PAQUITA
Middle Name:LEE
Last Name:MOYA
Suffix:
Gender:F
Credentials:LIC 8231
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1262
Mailing Address - Street 2:
Mailing Address - City:GURABO
Mailing Address - State:PR
Mailing Address - Zip Code:00778-1262
Mailing Address - Country:US
Mailing Address - Phone:787-737-6441
Mailing Address - Fax:787-737-1280
Practice Address - Street 1:CALLE ANDRES ARUZ RIVERA #166
Practice Address - Street 2:
Practice Address - City:GURABO
Practice Address - State:PR
Practice Address - Zip Code:00778
Practice Address - Country:US
Practice Address - Phone:787-737-6441
Practice Address - Fax:787-737-1280
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2010-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR8231207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
83773Medicare ID - Type Unspecified
E81606Medicare UPIN